High precision visual field tester with unprecedented detailed results

ABSTRACT

A visual field testing apparatus for scanning the visual field of a human eye in great detail, precision, and clarity so as to detect the smallest blind area whereby allowing users the ability of early detection of glaucoma and other eye diseases of visual loss. The apparatus is small and inexpensive so that anyone can afford to purchase it and self-test without assistance so that the user can test frequently at home which further leads to early detection of eye diseases. Because of its great precision and detail in test results, the present invention is especially useful to doctors and researchers. One embodiment of the present invention is a visual field tester which comprises: (a) a recording surface having eye fixation means to fixate an eye&#39;s visual field relative to said recording surface; and (b) a handheld scanning device which has a test mark for detecting very small blind areas in said eye&#39;s visual field and marking means for mapping said detected very small blind areas onto said recording surface.

CROSS-REFERENCE TO RELATED APPLICATIONS

Not Applicable

FEDERALLY SPONSORED RESEARCH

Not Applicable

SEQUENCE LISTING OR PROGRAM

Not Applicable

BACKGROUND OF THE INVENTION

This invention relates to a device and a method for detecting and mapping the diseased blind areas in a person's vision. The most widely used visual field tester today is the Standard Automated Perimeter (SAP) which is used to perform a contrast sensitivity test. In this test, a person is usually seated in front of a hemispherical projection surface whereupon an optical projection system projects circular spots according to an algorithm, and the subject responds to the stimulus by pressing an input device such as a mouse. Usually the algorithm used to project the spots of light is written so that the location and the timing of the projected lights are random to the user. This is to keep the user from falling into a rhythm and expectantly clicking on the input device even when he or she does not see the projected light. However, these SAP tests suffer from a number of disadvantages.

-   -   a) They are costly and most individuals would normally not be         able to afford them. SAP equipment require an expensive         projection system, software and hardware. The SAPs are usually         only found at hospitals and eye physicians' offices. As a         result, SAPs are not easily accessible devices. If someone         wanted to monitor the condition of one's own visual field, he or         she would not be able to run a visual field test often and         usually would have to make an appointment with a doctor to do         so.     -   b) SAPs are large bulky machines. They are not mobile machines         that can be transported anywhere. Current SAPs are large and         heavy and once they are placed at a certain location they cannot         be moved easily.     -   c) SAPs are prone to inaccuracies and sometimes do not detect         problems in the visual field until noticeable deterioration has         occurred. One of the problems with SAPs is that due to the         random generation of projected lights, users do not know where         the next light will appear; therefore, sometimes they will often         miss identifying certain lights because they were not prepared.         The SAP tests are time-constrained; while a user is pondering         whether or not to click the button, the next light appears.         Therefore, it is a man-machine contest with the user being quite         nervous in taking the test. Also, some machines require the user         to fixate his or her eye on a bright light in order to keep the         eye from wandering. However, blinking often creates after-images         which tricks subjects into seeing a projected light where none         was projected.     -   d) The result from SAPs do not show decisive results for each         location in the visual field. Due to the inaccuracies in the         SAPs, their algorithm usually displays or prints out a map of         the visual field with each area of the visual field given         different probabilities of damage or problems. This is done to         account for the user's errors in clicking or identifying random         lights. If the user did not click the button when a light was         projected, the result from the SAP would be inaccurate. Rather         than identifying an area where the subject could not see as a         problem area, the SAP might identify it as an area with medium         probability, but not definite probability.     -   e) Current visual field testers are not good at early detection         of glaucoma or other eye diseases. If glaucoma can be detected         early on, medication such as pressure-reducing eyedrops can be         given to stop the farther destruction of optical nerves in the         eye. Often, when glaucoma is detected, excessive damage to the         nerves in the eye has already occurred causing severe visual         field loss. Because of the uncertain outputs from SAP testers,         doctors and patients are often misled into believing glaucoma         does not exist, when in actuality, it is already present. For         example, a doctor may look at a result from a SAP and         incorrectly conclude that an area with medium probability next         to the natural blind spot is not problematic and is considered         part of the natural blind spot when in reality, nerve cells have         already begun to die in that region as is shown in the later         section under the title “Accurate Detection of Diseased Blind         Areas: FIGS. 15A-15B.”

OBJECTS

Accordingly, to overcome the disadvantages of current visual field testers as described above, and besides the objects of the visual field device described in our patent, several objects and advantages of the present patent are:

-   -   a) To provide a visual field tester which can detect glaucoma         and other eye diseases causing vision loss in their very early         stages by scanning the visual field in even greater detail and         accuracy, thus allowing early treatment.     -   b) To provide a visual field tester which can provide a decisive         output, indicating which areas in the visual field are         definitely good and which areas are definitely bad.     -   c) To provide an accurate visual field tester that allows the         user to have total control so that he or she can retest certain         areas of the visual field if he or she finds something unusual         or feels that an area has been missed.     -   d) To provide an inexpensive visual field tester that anyone can         afford and purchase readily.     -   e) To provide a small portable visual field tester that can be         easily transported.     -   f) To provide precise and detailed visual field test results for         a patient whereby his or her doctor can make a correct         diagnosis.     -   g) To provide accurate and detailed visual field mapping results         to help researchers track the progression of eye diseases under         different treatments and to help them find new cures and root         causes of eye diseases.

BRIEF SUMMARY OF THE INVENTION

The object of the present invention is to provide a new visual field tester for detecting, with decisive accuracy, glaucoma and other eye diseases with vision loss at the very early stages, and to provide a portable, inexpensive visual field tester that anyone can afford.

The invention includes a recording surface (typically a visual field grid sheet), a handheld scanning device, and an optional head support for reproducible test results.

The head support is comprised of a flat rigid frame with a T-shaped opening for a face and two rotating U-shaped support members. Under normal operation, the user would be seated or standing at a table with the visual field tester placed near the edge of the table. A user inserts his or her face into the T-shaped opening of the head support and positions the head using a mirror to align the center of the face with a line or notch on the bottom-side of the head support. In this way, the head support allows the head to be positioned exactly the same distance and orientation from a recording surface or visual field grid sheet each time, so that the test is repeatable and the progression of the eye disease can be evaluated by comparing results of each test.

A visual field grid sheet is clamped beneath the head support by use of a base board so that both the visual field grid sheet and head support are immobile. The base board is made of a rigid flat material and it has a clip on one side to clamp the visual field grid sheet and U-shaped support members of the head support. The base board can be made to fold to facilitate storage. The visual field grid sheet itself is in polar coordinates comprised of an eye fixation mark at the center, radial lines, and concentric circles centered about the eye fixation mark. The concentric circles corresponding to the visual angles of the eye under test. We shall refer to the blind area in a person's eye that corresponds to the area where the optic nerve joins the eye as the “natural blind spot” to follow conventional naming, and we shall refer to very small test areas that cannot be seen by the eye within the natural blind spot as “very small natural blind areas.” We shall refer to very small test areas that cannot be seen by the eye outside of the natural blind area as “very small diseased blind areas.” Likewise, we shall refer to a cluster of very small diseased blind areas as a “diseased blind area.” Also, we shall use the term “very small blind area” to refer to a very small blind area which could either be a very small diseased blind area or a very small natural blind area. During scanning, the user would focus one eye on the eye fixation mark of the visual field grid sheet while the other eye is closed, and he or she would use a handheld scanning device to scan through all areas of the visual field and find areas of very small diseased blind areas and very small natural blind areas. The handheld scanning device has a block for a hand to hold. Protruding from the block is a thin resilient stick with a small test mark, usually a small dot, on the top surface at the end of the stick. Directly below the test mark is a stamp the same size and shape as the test mark. During scanning whenever the test mark disappears from view, the user would push down on the stick with the index finger and stamp a corresponding mark or dot onto the visual field grid sheet. The user could follow one of several methodological ways of scanning the visual field grid sheet without missing any areas. The visual field grid sheet is divided by circles of visual angles and radial lines of polar angles into many small sections which facilitates the user to search thoroughly for diseased blind spots in a particular section. Unlike tests done with SAPs which are controlled by the machine, in the present invention, users can spend as much time as they need to scan a particular spot so that they are sure the spot is a very small diseased blind area before stamping a dot or mark on the visual field grid sheet. At the end of the test, the user will have an extremely detailed map of the visual field. When the test mark is in a completely blind area, including both the diseased blind area and the natural blind spot, the user cannot see the test mark at all. As soon as the test mark is moved away from a completely blind area, the user can see the test mark clearly. Thus the user can map the contours of both the diseased blind area(s) and the natural blind spot clearly and precisely, and be able to distinguish the two areas easily as will be shown later. Furthermore, the test mark can be made as small as the user can see; thus, very small diseased blind areas, typically in the early stage of the disease, can be detected. Therefore, the present invention enables early detection of glaucoma and other eye diseases with vision loss and the ability to monitor progression of eye diseases.

ADVANTAGES

In some cases a diseased blind area may not be completely blind, that is, the area has both dead and intact optical nerves intermingled together. In this case, to the user's eye, the test mark would appear to be grey if the test mark is black, or the test mark would twinkle as it is moved around slowly, and the user would use a different color to stamp a mark to map the very small blind area on the visual field grid sheet. Thus, our visual field tester can map both the areas of complete blindness and the areas of partial blindness. This is especially important when later the user finds that a partially blind area becomes completely blind indicating his/her disease is getting worse, although the overall blind area does not grow larger.

From the description above, a number of advantages of our visual field tester become evident.

-   -   a) With our visual tester, the user can detect and locate a very         small diseased blind area. That is, glaucoma and other eye         diseases with vision loss can be detected at a very early stage,         enabling the disease to be treated at a very early stage and         preventing the eye from further vision loss beyond this early         stage.     -   b) Furthermore, the visual field tester can be cheaply made so         that everyone can afford to possess it and use it as frequently         as he or she wants, which increases the chance for early         detection of the disease.     -   c) The head support of our visual field tester can be folded,         thus allowing the visual field tester to be extremely compact.         The head support and handheld scanning device are small enough         to be stored or carried around in a briefcase.     -   d) The user can re-scan certain regions of his or her visual         field and use smaller test marks or dots to obtain a visual         field map with even finer resolution. In certain spots in the         visual field that seem to be trouble spots, the user can retest         those areas several times to ensure accurate results.     -   e) The output from our visual field tester shows exactly which         areas of the visual field have problems and does not arrive at         results based on a probability.     -   f) With our visual field tester the user can map not only         completely blind areas, but also partially blind areas.         Therefore, if a user's partially blind area becomes completely         blind even though the overall blind area does not get larger, he         or she will know the eye disease is getting worse.

CONCLUSION, RAMIFICATIONS AND SCOPE

Accordingly, a visual field test can be performed by anyone anywhere using the visual field tester described in this patent. In addition, the visual field tester of the present invention has the additional features in that:

it allows production of visual field testers at low cost, allowing individuals, rather than only hospitals and doctors to purchase them.

it permits a visual field tester to be compact and portable.

it provides a visual field tester that will give extremely accurate results as patients can rerun the test themselves on trouble spots by using a smaller test mark for finer resolution.

it gives decisive results on whether a specific area in the visual field has problems.

Although the description above contains many specifications, these should not be construed as limiting the scope of the invention but as merely providing illustrations of some of the presently preferred embodiments of the invention. Thus, the scope of the invention should be determined by the appended claims and their legal equivalents rather than by the examples given.

BRIEF DESCRIPTIONS OF THE DRAWINGS

FIG. 1 illustrates the major components of the visual field tester according to the present invention and how it is used by a user;

FIG. 2 is a perspective view of the head support and visual field grid sheet (recording surface);

FIG. 3 is a perspective view of the head support of the visual field tester in an opened position;

FIG. 4 is a perspective view of the head support of the visual field tester in a compact folded position;

FIG. 5 is a perspective view of the base board of the visual field tester;

FIG. 6A is a perspective view of the handheld scanning device of the visual field tester;

FIG. 6B is a view of the underside of the resilient stick of the visual field tester where a stamp is located;

FIG. 6C is a side view of a user rewetting ink to the stamp on the handheld scanning device;

FIG. 7 is a top view of the visual field grid sheet (recording surface) of the visual field tester where optional vertical guide lines and horizontal guide lines are shown;

FIG. 8A is a perspective view of an alternate embodiment of the visual field tester in which the head support is not foldable;

FIG. 8B is an exploded view of an alternate embodiment of the visual field tester shown in FIG. 8A;

FIG. 9A is a perspective view of an alternate embodiment of the visual field tester in which the head support only has support members close to the forehead;

FIG. 9B is an exploded view of an alternate embodiment of the visual field tester shown in FIG. 9A;

FIG. 10A is a perspective view of an alternate embodiment of the visual field tester in which the head support only has support members close to the chin positioner;

FIG. 10B is an exploded view of an alternate embodiment of the visual field tester shown in FIG. 10A;

FIG. 11A is a top view of an alternative embodiment of the visual field tester in which the handheld scanning device comprises a substantially flat object and a marking tool;

FIG. 11B is a top view of the alternative embodiment of FIG. 11A where a user is aligning the marking tool's marking tip to the flat object's test point;

FIG. 11C is a top view of the alternative embodiment of FIG. 11A where a user has placed a mark onto the recording surface;

FIG. 11D is a top view of another alternative embodiment of the visual field tester in which the handheld scanner comprises only a marking tool;

FIG. 12A is a top view of a user performing a horizontal scan using the rectangular guide with the test mark pointed downwards from the hand holder;

FIG. 12B is a top view of a user performing a horizontal scan using the rectangular guide with the test mark pointed upwards away from the hand holder;

FIG. 13A is a top view of a user performing a diagonal scan using the rectangular guide with the test mark on the right side of the hand holder; the same method can be applied for a vertical scan;

FIG. 13B is a top view of a user performing a diagonal scan using the rectangular guide with the test mark on the left side of the hand holder; the same method can be applied for a vertical scan;

FIG. 14A is a test result of a normal eye of one of the present inventors using the present invention, which shows that a natural blind spot is a polygon;

FIG. 14B is a test result of a normal eye of another present inventor using the present invention, which shows that a natural blind spot is a polygon;

FIG. 15A is a test result of a glaucoma patient obtained from a SAP machine; the name of the patient will not be revealed to protect privacy;

FIG. 15B is a test result using the present invention of the same patient from FIG. 15A;

FIG. 16A is a top view of a visual field grid sheet modified for people with macular degeneration or other eye disorders with central vision loss; and

FIG. 16B is a close-up top view of the visual field grid sheet of FIG. 16A.

DETAILED DESCRIPTION OF THE INVENTION Description: FIGS. 1-13

A preferred embodiment of the present invention is illustrated in FIG. 1 and FIG. 2. A user positions his or her head using a head support 40. The preferred embodiment's head support 40 can position the head the same orientation and location relative to a recording surface (typically visual field grid sheet) 100 each time the test is performed. Thus, each time the user takes a visual field test with the present invention, the visual field tester's mapping results would be reproducible, and any changes in the visual field would show up as a change in the test results as compared to the previous one. If the user chooses, he or she could run the test without using the head support. He or she would place visual field grid sheet 100 (recording surface) on a flat surface such as a table, keep the head a fixed distance from sheet 100, and hold the head still while performing the test. The disadvantage of not using the head support is that if the user later wishes to perform additional tests, results would not be reproducible in that the map of the blind spots would not have the same reference point. Head support 40 consists of a rigid frame 41, a tilting mirror 50, and a base board 47.

FIG. 3 shows rigid frame 41 in an opened position while FIG. 4 shows rigid frame 41 in a closed position for storage. In the opened position, a user inserts his or her face into a face opening 44 that is located on rigid frame 41. At one end of face opening 44, a chin positioner 42 protrudes vertically from rigid frame 41. On the opposite side of face opening 44 is a notch 43 that the user aligns with the center line of the user's face as he or she looks at mirror 50. A dark line 52 (FIG. 4) protruding from notch 43 on the bottom of rigid frame 41 further aids in alignment of the center line of the user's face. A soft pad 60 is affixed on the top side of rigid frame 41 where a user would place his or her forehead. During test, much of the weight of the head is placed against the forehead so that soft pad 60 alleviates any discomfort. Situated at the four corners of rigid frame 41 are a front left insertion hole 57, a front right insertion hole 56, a rear left insertion hole 59 and a rear right insertion hole 58 (FIG. 4). A front U-shaped support member 54 plugs into holes 56 and 57 while a rear U-shaped support member 55 plugs into holes 58 and 59. A hook 65 is attached to a leg of U-shaped support member 55, and a hook 64 is attached to a leg of U-shaped support member 54. Bulges 51 and 53 on U-shaped support members 54 and 55 hold the hooks 64 and 65 in place so they do not slide up or down the legs. When rigid frame 41 is opened, hook 65 is inserted into a left hook hole 61 and hook 64 is inserted into a right hook hole 62. Hooks 64 and 65 lock U-shaped support members 54 and 55 in place so they are immobile when rigid frame 41 is in an opened position for use. At the center of the bottom segments of U-shaped support members 54 and 55 are alignment marks 66 and 67, respectively. When folded, rigid frame 41 becomes substantially flat and compact allowing easy carriage and storage. As shown in FIG. 4, rotatable hooks 64 and 65 are unplugged from their holes 61 and 62, thus allowing the two U-shaped support members 54 and 55 to freely rotate. U-shaped support members 54 and 55 are rotated inwards towards the bottom of rigid frame 41 for storage.

FIG. 5 illustrates a base board that is a preferred embodiment of the present invention. In this embodiment, two flaps 74 and 75 are joined by folds, hinges, or creases 76 and 77, respectively, to a main board 203. Attached to the top-side of board 203 is a clip 201. Flaps 74 and 75, when unfolded outwards from main board 203, will create a flat surface for placing visual field grid sheet 100 (recording surface) (FIG. 1). During storage or carriage, flaps 74 and 75 are folded inwards to save space. On the top of base board 203 is a base board alignment line 205 which is used to align the y-axis of visual field grid 100 and alignment marks 66 and 67 on U-shaped support members 54 and 55 of head support 40.

FIGS. 6A-6C show a preferred embodiment of a handheld scanning device 91. It consists of a hand holder 92, a resilient stick 95 inserted into an insertion hole 93 of hand holder 92, and an inkpad 30. On one end of resilient stick 95 is an enlarged area 98, typically the shape of a circular disc. A test mark 97 is at the center of the top side of enlarged area 98. A stamp 99 is affixed directly beneath test mark 97 on the bottom side of enlarged area 98. Resilient stick 95 is slightly curved down so that when hand holder 92 rests on visual field grid sheet 100, stamp 99 is only slightly elevated above visual field grid sheet 100 (recording surface). Resilient stick 95 can be changed to another stick with test mark 97 of different size and corresponding stamp 99 of corresponding size if the user wishes to; For example, if the blind area in the user's visual field is quite large, he or she may use a resilient stick with a larger test mark or dot for faster scanning and then change to a stick with a smaller mark or dot for detailed scanning on the contour of the blind area.

FIG. 7 shows visual field grid sheet 100 (recording surface). An eye fixation mark 101 is located at the center of sheet 100. Centered about fixation point 101 are several concentric circles corresponding to the visual angles of the eye under test. The visual angle can be calculated from the formula:

Visual angle=tan⁻¹(r/h)

where r is the radius of a circle of a given visual angle and h is the vertical distance between the tested eye and the fixation point 101 where the tested eye is approximately vertically above the fixation point 101. For example, a circle 35 corresponds to visual angle 35 degrees. Lines radiating from the eye fixation mark correspond to the polar angles of the test eye. For example, a radial line 150 corresponds to polar angle 150 degrees. Optional horizontal lines 70 and vertical lines 71 can be used to aid in scanning which will be explained in more detail in the operations section.

As stated above, the tested eye is approximately vertically above the fixation point 101. This is because the middle point between two eyes is vertically above the fixation point 101, and, hence, each eye is only approximately vertically above the fixation point 101. It does not affect the performance of our visual field tester at all. It does not affect any of the advantages of the present invention stated above in the section under the title “Brief Summary of the Invention”.

Alternative Embodiments FIGS. 8-10

Additional embodiments are shown in FIGS. 8A-8B, FIGS. 9A-9B, FIGS. 10A-10B, and FIGS. 11A-11D. Referring to FIG. 8A, head support 40, instead of having two rotatable or folding support members, has unfoldable support members 81 to facilitate manufacturing. As shown in FIG. 8B, base board 47 has an indentation 80 to fit mirror 50 snugly in place and four indentations 83 to fit support members 81. Clip 201 has an alignment line 204 in addition to center line 205 to align with the y-axis of the visual field grid sheet 100 (recording surface).

FIGS. 9A-9B show another embodiment which has one or more support members, typically two support members 81, affixed near soft pad 60 on rigid frame 41, but which has no support member(s) near chin rest 42. Two diagonal support structures 85 keep rigid frame 41 from drooping down under downward pressure when a user places his or her head onto head support 40. Support members 81 are affixed to base board 47 by any fasteners, typically by screws 82 through threaded holes 84.

FIGS. 10A-10B show another embodiment which has one or more support members, typically two support members 81, affixed to rigid frame 41 near chin positioner 42, and which has no support member(s) near soft pad 60. Here, rigid frame 41 is modified so that soft pad 60 is no longer used. Diagonal support structures 85 give support to rigid frame 41, and support members 81 are affixed to base board 47 by any fastener, typically by screws 82 through threaded holes 84. Since there are no notch 43 and alignment line 52 on rigid frame 41 to align the center line of a user's face, the alignment is accomplished by having an alignment line 63 on mirror 50, which is to be aligned with the center line of the user's face as he or she looks at mirror 50. FIG. 10B shows that mirror 50 fits snugly into indentation 80 in base board 47 and mirror 50 can only be tilted up and down so that line 63 on mirror 50 always aligns with center line 205 on base board 47.

So far, the head support described above can produce reproducible test results. If the user's only concern is to detect diseased blind spots but not care about the reproducible test results, then a simple head support can be used, which is described as follows. A typical simple head support includes a vertical rod with one end attached to the visual grid sheet (recording surface) and the other end propped against the user's forehead. This head support does not need to have a mirror or base board.

FIGS. 11A-11C show another embodiment of the handheld scanning device, and FIG. 11D shows yet another embodiment of the handheld scanning device. In the present invention, the handheld scanning device includes anything that has a test mark, which a user can perceive with his or her peripheral visual field, and that can place a corresponding mark on the visual field grid sheet (recording surface) at the location of the test mark. Referring to FIGS. 11A-11C, one alternative embodiment comprises a flat object 401 such as a piece of paper or thin strip of plastic. Located on the top surface of flat object 401 is test mark 97. In addition, a marking tool or marking apparatus 402 such as a pencil, pen, or marker which has a marking tip 403 will be used to place a mark 404 whenever the user cannot see test mark 97. Referring to FIG. 11D, a simpler alternative embodiment of the scanning device is shown where marking tip 403 on marking apparatus 402 also functions as the test mark. The operation of these embodiments will be discussed in greater detail in the operations section.

Operation: FIGS. 1-12

To use the present invention, the user first clamps visual field grid sheet 100 (recording surface) onto base board 47 as shown in FIGS. 1-2. The user would align a y-axis 270 (that is, 90° radial line and 270° radial line) of visual field grid sheet 100 (recording surface) with alignment line 205 on base board 47, and then clamp the bottom part of U-shaped support member 55 with clip 201 such that alignment marks 66 and 67 of both U-shaped support members align with the y-axis of visual grid sheet 100 (recording surface). In the alternate embodiments in FIGS. 8-10, line 204 on clip 201 and line 205 on base board 47 would align with y-axis 270 on visual field grid sheet 100 (recording surface). The user would then look at tilting mirror 50 and position the head until the center line (symmetric line) of the face aligns to notch 43 and/or line 52 (shown in FIG. 3 and FIG. 4) underneath rigid frame 41 or line 63 on mirror 50 (FIG. 10A). An image 300 in the mirror in FIGS. 1, 8A, 9A, 10A illustrates a head aligned correctly. Once the head is positioned, the user stares with one eye (the other eye is closed) at fixation point 101 located at the center of visual field grid sheet 100 (recording surface).

The user could also use the head support without the baseboard which would give less stability. Here, the user would place the rigid frame on top of the recording surface. Also, a user may also not use a head support at all if he or she is not interested in reproducible results. The user would simply need to hold the head a predetermined distance from the recording surface and hold the head still while running the test. Results from such a test would still be useful in that diseased blind areas would be detectable and any changes in the shapes of the diseased blind areas would be detectable, but the disadvantage is that the exact coordinates of these diseased blind areas would not be known.

Using the right hand or left hand, the user would grasp handheld scanning device 91, and slide it systematically on visual field grid sheet 100 such that the movement of test mark 97 would encompass the whole visual field. As the user moves handheld scanning device 91, he or she would keep the test eye staring at fixation point 101 while using the test eye's peripheral vision to see test mark 97. If test mark 97 disappears from the test eye's peripheral vision, then the user stops moving handheld scanning device 91 immediately and presses down resilient stick 95 which will in turn cause stamp 99 to stamp a mark or dot on visual field grid sheet 100 (recording surface). The user can either use a finger of the hand that is holding handheld scanning device 91 or any finger of the other hand to press resilient stick 95. The user not being able to see test mark 97 with the peripheral vision indicates that the user has a very small blind area in the visual field, and by stamping the corresponding mark on visual field grid sheet 100, the user maps the very small blind area onto visual field grid sheet 100.

After test mark 97's movement covers the entire visual field grid sheet 100 and all very small blind areas found have been stamped, the complete map of very small blind areas in the visual field of the eye just tested is obtained. In the course of scanning, instead of test mark 97 completely disappearing, the user may find that test mark 97 does not disappear completely at a particular spot. This is because the very small blind area is smaller than test mark 97. For better resolution, the user would change resilient stick 95 (shown in FIG. 6A) to one with a smaller test mark 97. For this purpose, the present invention includes several resilient sticks 95 with different sizes of test marks 97, and resilient stick 95 can be easily changed by pulling out existing resilient stick 95 from hole 93 in hand holder 92 in FIG. 6A and pushing in another resilient stick 95 into hole 93. Thus the present invention can detect a very small blind area in the earliest stage of eye disease with vision loss.

If the user finds that test mark 97 twinkles as it is moved around slowly, then the area being scanned is an incompletely or partially blind area. That is, there are many dead optical nerves and intact optical nerves intermingled. In this case, the user would use a different color to stamp the very small blind area on the visual field grid sheet. Later, if the user cannot even see test mark 97 twinkling in that area, then the user and the eye doctor would know that the area became completely blind, and that the eye disease is getting worse even though the overall blind area did not enlarge.

To rewet stamp 99 with ink, the user tilts hand holder 92 up slightly so that stamp 99 is tilted up to allow inkpad 30 to slide beneath stamp 99 as shown in FIG. 6C. The user presses down resilient stick 95, and stamp 99 touches inkpad 30 to rewet stamp 99 with ink. Resilient stick 95 is made of resilient material, typically metal or plastic so that it will rebound and return to the original shape after being pressed down and released either to rewet stamp 99 with ink or to stamp a dot on visual field grid sheet 100 when a very small blind area is perceived. Once stamp 99 is rewetted, it can stamp several times before it needs to rewet again. Therefore, it can stamp very fast in a blind region.

Stick 95 and enlarged area 98 (excluding test mark 97) have the same color as visual field grid sheet 100, typically white, to allow them to camouflage with the visual field grid sheet during scanning. The reason for having enlarged area 98 is that during scanning, the user will only perceive the movement of test mark 97, and all surrounding stamped marks and grid lines will be blocked out by enlarged area 98.

The ink used for inkpad 30 can be any color. One way of tracking the progression of an eye disease is to use different colored ink every time the test is performed. Thus, on subsequent tests, by using the same visual field grid sheet 100 previously used, the new very small diseased blind areas can be differentiated from the previous areas because the colors will be different.

In order to obtain more precise scanning, FIGS. 12 and 13 show the use of a rectangular guide 96. The purpose of using rectangular guide 96 is to assist the user in scanning an area in doubt with very fine detail. FIGS. 12A-12B show a method for horizontal scanning. FIG. 12A illustrates how to scan the lower part of test grid sheet 100 and FIG. 12B illustrates how to scan the upper part of visual field grid sheet 100. In both cases, the method is as follows. First, the user places rectangular guide 96 on visual field grid sheet 100 parallel to horizontal lines 70 on visual grid sheet 100 (FIG. 7). Then the user uses his or her thumbs and index fingers of both hands to hold hand holder 92 and presses a back edge 94 of hand holder 92 against guide 96 in the case of FIG. 12A, or a front edge 20 of hand holder 92 against guide 96 in the case of FIG. 12B. All the other fingers are used to press down rectangular guide 96 firmly so that it will not move. Then the user slides hand holder 92 slowly along rectangular guide 96 to scan for very small blind areas. When the user perceives a very small blind area, he or she stops sliding hand holder 92 immediately. While holding hand holder 92 and rectangular guide 96 firmly with one hand, he or she uses any finger of the other hand to press down resilient stick 95 to stamp a mark on visual field grid sheet 100.

The advantages of using rectangular guide 96 are as follows. First, the user can move hand holder 92 very slowly and at a steady pace, so that his or her eye can perceive the disappearance of test mark 97 very clearly when a very small blind area is encountered. Secondly, after one line is scanned, the user can proceed to scan another line by moving rectangular guide 96 up (or down, if the scanning starts from the top of the area to be scanned) in very small increments with a distance slightly smaller that the diameter of test mark 97 while still keeping rectangular guide 96 horizontal, that is, parallel to the horizontal lines on test grid sheet 100. This process would be repeated until the area in doubt is completely scanned. Thus no blind spots in that area would escape detection.

FIGS. 13A-13B show a method for scanning vertically or in a slanted direction. FIG. 13A shows how to scan the right part of the visual field grid sheet 100 and FIG. 13B shows how to scan the left side of visual field grid sheet 100. The user first places rectangular guide 96 either parallel with vertical lines 71 (FIG. 7) or in a slanted direction. In FIG. 13A, the user uses a right hand 21 to hold down rectangular guide 96. A left hand 22 holds hand holder 92 using the thumb, index finger and middle finger and places back edge 94 against rectangular guide 96. In this way, the user can slowly slide hand holder 92 along rectangular guide 96 and use the index finger of left hand 22 to press down resilient stick 95 to stamp a mark. In FIG. 13B, the user uses left hand 22 to hold down rectangular guide 96 and right hand 21 to grasp hand holder 92 with its index finger, thumb and middle finger. Here, the user can slowly slide hand holder 92 along rectangular guide 96 using right hand 21 and stamp a mark with the index finger of right hand 21.

In the case of the alternate embodiment of the scanning device in FIGS. 11A-11C, the user would grasp flat object 401 and slide it around the visual field grid sheet (recording surface). Whenever test mark 97 disappears from view, the user moves marking tool 402 such that marking tip 403 is directly above or below test mark 97 (FIG. 11B). Then the user removes flat object 401 slightly away so that marking tip 403 can make a mark 404 on the visual field grid where test mark 97 had originally been (FIG. 11C).

In the case of the alternative embodiment of the scanning device in FIG. 11D, the marking tip 403 on marking tool 402 also is the test mark. In this way, when a user moves marking tool 402 about the visual field grid sheet and marking tip 403 disappears from view, the user would stop moving the tip and make a mark on the visual field grid sheet or recording surface at the location where marking tip 403 disappears.

Natural Blind Spot and New Discovery: FIGS. 14A-14B

It is well known that everyone has a blind spot at the location where the optic nerve from the brain enters the eye. Because this natural blind spot is not covered with retinal cells, it cannot perceive light. Eye diseases such as glaucoma, macular degeneration, and so forth will cause visual loss in other parts of the visual field. These visual loss areas caused by diseases will be called “diseased blind areas.”

Before the present invention, only the approximate location of the natural blind spot in the visual field was known, and there was no visual field tester that was accurate enough to map out the shape of the natural blind spot in the visual field grid sheet. The natural blind spot is only known to exist between the 10 degree and 20 degree visual angles, on around the negative x-axis for the left eye and on around the positive x-axis for the right eye.

With the present invention, for the first time, the exact shape, size, and location of the natural blind spot has been found by the present inventors as shown in FIGS. 14A and 14B. FIGS. 14A and 14B are reduced copies from the original test grid sheet of 11″×17″ for the right eye natural blind spot. Inside the natural blind spot, nothing can be seen; hence, test mark 97 cannot be seen when scanning inside a natural blind spot 103. When test mark 97 is moved across the boundary of natural blind spot 103 to the outside, the user's perception of test mark 97 changes from being completely invisible to being clearly visible, with no transition or blurred image in between. Thus, the boundary of natural blind spot 103 can be precisely located and mapped (stamped) on visual field grid sheet.

FIGS. 14A and 14B show that the shape and the size of natural blind spot 103 are different from person to person. It is not a circle, rather a polygon of five sides (FIGS. 14A and 14B) or four sides (FIG. 15B). Note that in FIG. 14A, one side (the upper side) of the polygon is not straight.

The ability of the present invention to precisely map the natural blind spot will help doctors diagnose the progression of patients' eye diseases and help researchers correlate blind spot shape and/or size with some diseases including eye diseases, brain tumors, and so forth, because changes to blind spot shape and/or size are important in the detection of such diseases.

Accurate Detection of Diseased Blind Areas: FIGS. 15A-15B

The prominent advantages of the present invention are the detailed and clear scanning results, which enables one to early detect vision loss related to eye diseases such as glaucoma, macular degeneration, . . . etc. In visual field tests with SAPs, the light appears at only a limited number of points in the visual field. Therefore, the whole visual field is not covered by the test and some very small blind areas which occur at early stages of the disease will most likely be undetected. In the present invention, test mark 97 can be moved continuously as described above by using rectangular guide 96 to scan closely line by line the entire visual field so that no very small diseased blind area will escape from detection.

Furthermore, the detail and clarity in the scanning result of the present invention enables one to differentiate the diseased blind area from the natural blind spot around the natural blind spot area as in contrast to the SAP test which shows the diseased blind area and the natural blind spot as one fuzzy lump, causing doctors to misdiagnose as described in the following. FIG. 15A is the test result taken with a SAP of the left eye of a glaucoma patient, whose name will not be revealed to protect privacy. Note that in this machine plot of FIG. 15A, doctors knew that two fuzzy lumps 104 and 105 were actually one single fuzzy lump, which was just separated by the negative x-axis and its scale. Two of the patient's doctors, including one glaucoma specialist, knew that fuzzy lumps 104 and 105 were at the approximate location of the natural blind spot. Therefore, both doctors told the patient that fuzzy lumps 104 and 105 were just the natural blind spot and that there was no diseased blind area there. A week prior to the doctor's tests, the patient used the present invention to scan the same eye, and the result is shown in FIG. 15B. It was a trial test with no charge to the patient. The result as shown in FIG. 15B was amazing. FIG. 15B clearly shows two distinct blind areas: (1) A normal left eye natural blind spot 107 which is about the same size but in the opposite location of the right eye's natural blind spot 103 of FIG. 14. (2) A diseased blind area 106 which has no definite shape and is clearly distinguishable from natural blind spot 107. Thus it is seen that the present invention is able to detect the diseased blind areas in the vicinity of the natural blind spot, and because of its detail and clarity, doctors will be able to properly diagnose a diseased eye that would have been misdiagnosed as a healthy eye by SAPs.

Macular Degeneration: FIGS. 16A-16B

In the early stages of macular degeneration, one's vision may have small diseased spots which may appear as (1) blank spots or blind spots (2) blotches, that is, gray or black stain-like spots, (3) blurred spots, or (4) distortion spots where straight lines appear wavy.

The present invention can be used to detect the above-mentioned types (1), (2), and (3) diseased spots from the early stages of macular degeneration. In this test, a bright color, say red, will be used for test mark 97 so that it is clearly distinguishable from type (2) diseased spots, that is, gray or black stain-like spots. Different colored inkpads can be used for different types of diseased spots. The user should write a note or legend on visual field grid sheet 100 as to which ink color is used for what type of diseased spot.

In the later stages of macular degeneration, the diseased spots may cover eye fixation mark 101 at the center of visual field grid sheet 100. Therefore, eye fixation mark 101 cannot be seen by the test eye; hence it cannot be used to fix the test eye in this special case. To fix the test eye for this case, the natural blind spot will be used as follows. As mentioned above, the boundary of the natural blind spot is very sharp and when test mark 97 is moved across the boundary from the outside to the inside of the natural blind spot, the eye will perceive test mark 97 from being clearly visible to being completely invisible with no fuzzy transition image in between. Furthermore, the present invention has clearly identified the location and size of the natural blind spot; therefore, referring to FIG. 16A and FIG. 16B, we can put two marks 305 and 301 adjacent to one another aligned horizontally on visual field grid sheet 100. Mark 305 is outside and mark 301 is inside of an expected natural blind spot 304 of the left eye. Note that since the shape of the natural blind spot differs from person to person, in FIG. 16B, we shall approximate that natural blind spot 304 is represented by a circle. Marks 305 and 301 are slightly below the negative x-axis, that is, at about the 185 degree polar angle and about the 18 degree visual angle. Eye fixation using these two dots 305 and 301 can be done as follows. Since the patient's central vision is diminished, he or she should use his or her peripheral vision to perceive two marks 305 and 301 by turning the left eye from the left to the right. At first, two marks 305 and 301 will both appear, indicating that they are on the right side of natural blind spot 304. Then the two marks disappear indicating that they are inside the natural blind spot 304. Then the two dots appear again. At that moment, two marks 305 and 301 are just outside the left edge of the natural blind spot. Then, the user fine-tunes the position by turning his or her left eye very slowly to the left until one of two marks, that is mark 301, disappears. That is, mark 301 is just inside natural blind spot 304 and mark 305 is just outside. Holding this position to perform the diseased spot scanning would ensure proper fixation.

The test eye can be further fixed in the vertical direction by having another two marks 302 and 303 adjacent to one another on visual field grid sheet 100 aligned vertically across the upper edge of the natural blind spot. Two marks 302 and 303 are located slightly above the negative x-axis, that is, 173 degree polar angle and at the 16 degree visual angle. After the user has horizontally fixed the left test eye with marks 305 and 301, he or she would then move the eye slowly up or down until mark 303 disappears from view while 302 remains. In this position, only marks 305 and 302 are visible. Holding this position, the user would then be able to scan without requiring a fixation point. This method of using horizontally aligned marks 305 and 301 and vertically aligned marks 302 and 303 for the eye fixation is more difficult to perform and can only be used by skillful users. For the unskillful user, using only horizontally aligned marks 305 and 301 is sufficient.

FIG. 16A also shows two horizontally aligned marks 309 and 306 and two vertically aligned marks 307 and 308 for testing the right eye. These marks are symmetrical about the y-axis with the dots mentioned above for the left eye testing and would be used to fix the right eye in the similar manner as described above. That is, marks 309 and 306 are located about the 18 degree visual angle and about the 355 degree polar angle, and marks 307 and 308 are located at about the 16 degree visual angle and about the 7 degree polar angle for right eye scanning. 

1. A visual field tester comprising: a recording surface having eye fixation means to fixate a human eye's visual field relative to said recording surface; and a handheld scanning device which has a test mark for detecting very small blind areas in said human eye's visual field and marking means for mapping said detected very small blind areas onto said recording surface.
 2. The visual field tester of claim 1 wherein said eye fixation means comprises an eye fixation mark on said recording surface for a user with central part of visual field intact.
 3. The visual field tester of claim 1 wherein said eye fixation means comprises one or more marks inside an expected natural blind spot and one or more marks outside said expected natural blind spot on said recording surface for a user with central part of visual field lost.
 4. The visual field tester of claim 1 wherein said handheld scanning device comprises: a test mark; a hand holder; a resilient stick which is attached to said hand holder wherein said test mark is on the top side of said resilient stick; a stamp on the bottom side of said resilient stick just beneath said test mark; and an inkpad.
 5. The visual field tester of claim 1 wherein said handheld scanning device comprises a marking tool which has a marking tip, wherein said marking tip functions as both said test mark and said marking means for mapping said detected very small blind areas onto said recording surface.
 6. The visual field tester of claim 1 wherein said handheld scanning device comprises: a substantially flat object having said test mark on the topside of said flat object; and a marking tool.
 7. The visual field tester of claim 1 further including means for supporting a user's head a fixed distance to said recording surface.
 8. The visual field tester of claim 7 wherein said means for supporting said user's head comprises: a rigid frame with an opening for a user's face to rest comfortably in and for the user's eyes to see said recording surface; and one or more support members for supporting said rigid frame.
 9. The visual field tester of claim 8 wherein said rigid frame has a chin positioner.
 10. The visual field tester of claim 8 further including means for aligning center line of said user's face relative to said recording surface whereby test results are reproducible.
 11. A visual field tester that comprises: a recording surface with an eye fixation mark to allow a user to fixate an eye that is being tested; a head support to position a test user's head relative to said recording surface; and a handheld scanning device to translate very small natural and diseased blind areas onto said recording surface whereby allowing user the ability to map his or her visual field onto said recording surface without requiring assistance from another person.
 12. A method of testing the visual field of a human eye comprising the steps of: positioning a user's head relative to a recording surface; fixating said human eye; moving a handheld scanning device, which has a test mark, about said human eye's peripheral vision on said recording surface; and placing a corresponding mark unto said recording surface each time said human eye's peripheral vision cannot perceive said test mark, whereby said corresponding mark indicates the corresponding location of a very small diseased or natural blind area of said human eye on said recording surface. 